South Africa 
The battle against AIDS brought to the schoolyards

Dr. Molefi Sefularo, MEC for Health in South Africa's North West Province, said yesterday in Mafikeng that the partnership approach proceeds from the premise that the integrated programmes on HIV/AIDS can only succeed if they are based on the collective knowledge, commitment, skills and action of  people across all sectors.

- To paraphrase the South African President, Thabo Mbeki: AIDS is not someone else's problem. It is my problem. It is your problem. My action counts. Your action counts. Our action counts.

The following statistics are worth noting: Since 1980, HIV has infected more than 47 million people in the world. It has already cost the lives of nearly 14 million people. Sub-Saharan Africa is the region in which four-fifths of all AIDS deaths occurred in 1998. South Africa has the fastest growing epidemic in the world. An estimated three and a half million were infected by the end of 1998. One in eight adults is infected with HIV. 

In South Africa alone, there are an estimated 1600 new infections daily. Within three years, almost a quarter of a million South Africans will die of AIDS each year and this figure will have risen to more than half a million by 2008. This will require intensified care and support for those infected and affected. The saddest part of this reality is that many of those who are HIV-positive do not know their status. 

- Already, the public health system is beginning to feel the strain. In the next few years, South Africa may not be able to cope with the devastating effects of HIV/AIDS unless this trend is reversed. This demands that all people, collectively and individually, redouble their efforts to help combat the AIDS epidemic. The problem of AIDS is not the problem of the Department of Health alone. It is not the problem of government alone. It is our problem. All of us, in our respective fields, positions or callings can contribute to the goal of defeating the scourge of AIDS. 

- People must acknowledge that HIV/AIDS is not the first epidemic or pandemic to confront humanity, Africa or Southern Africa, Dr. Molefi Sefularo said. The sun is not necessarily setting on humanity! There are numerous examples in history that show what can happen when an unfamiliar infection attacks a population for the first time. 

The bubonic plague pandemic, otherwise known as the Black Death of fourteenth century Europe is the chief example, followed by the cholera epidemics of the nineteenth century. We were later to see Rinderpest invading Africa in 1891, killing up to 90% of domesticated cattle as well as antelope and other wild species. Measles followed hard on the heels of small pox, spreading through Mexico and Peru in 1530-31. In Europe, the first outbreak of the influenza epidemic which lasted from 1556 to 1560 killed no less than 20% of the population in England. The central message on HIV/AIDS, therefore, must be of hope and of humanity's capacity to triumph over adversity and tragedy. 

Many individuals, families, communities, nations and people living with AIDS have turned what appears to be a death sentence to a life of hope. Hope is further strengthened by the determination of the people of the world, represented by delegates at the 13th International AIDS Conference, to overcome AIDS. There is also a glimmer of hope for a vaccine, although it is at least seven years away. 

Youths are the hardest hit by this epidemic. This reality underlines the crucial role that  schools should play in the fight against this pandemic. The recent UNAIDS report shows that most of the affected people are young / adolescents. Clearly, the impact of HIV/AIDS on  youths are particularly devastating. 

According to UNAIDS, in countries such as South Africa and Zimbabwe, where a fifth or a quarter of the adult population is infected, AIDS is set to claim the lives of around half of all 15-year olds. In the North West Province, the 1999 figures suggest that it is registered the most significant increases in the age-groups 14-19 years, 25-29 years and 25-39 years. The least increase has been in the age groups 20-24 years, 30-34 years and over 40 years. 

South Africa is beginning to witness deaths of adults in their thirties and forties who were infected when they were young. Some are listening while others are not responding to the messages and the evidence of the seriousness of the HIV/AIDS epidemic. There are a number of reasons why school children and the youth in general are more vulnerable than their older counterparts.

Misinformation 
Most of the youth do not have the right information on sexuality, sexually transmitted diseases, the consequences of sex and HIV/AIDS, Dr. Molefi Sefularo claims. They either get half-baked information from newspapers or friends who in turn are also misinformed. They therefore need to be informed by people who are well versed with the subject of sex et cetera.

Ignorance
As stated above the youth are ignorant about how one transmits and catches HIV/AIDS and other sexually transmitted diseases. They need life skills education to inform them about the facts of life.

Experimentation
Most youths experiment on sex during their teenage years, They want to try all that they hear in newspapers, magazines, journals et cetera. Some experimental sex increases the risk of HIV/AIDS transmission.

High Sexual Activity
Research has shown that the youths in most countries of the world are the most highly sexual active age group. The higher the sexual exposure the higher the risk of infection especially when their age group has the highest prevalence. 

Lack of empowerment
The youth are under the control of adults. Girls in particular have sex with people older than they. These people have more power over them such that the youth are not assertive enough to negotiate for safer sex.

Physique
The genital lining of the youth and girls in particular is still not well developed to protect the viral transmission into the body. Older women have harder vaginal mucosal lining which does not easily break during the act of sex, that of the young girls is still very tender and breaks easily thus increasing chances of infection.

A key element of the plan is to escalate prevention efforts. This is focused particularly on the youth and includes the introduction of life-skills programmes in schools as a compulsory part of the curriculum. It also includes peer education and social mobilisation. Although school children, like the rest of the youth, may be highly susceptible to sexually transmitted infections, as a group, they offer a unique opportunity in which HIV/AIDS prevention and education can be provided to a large captive audience in a disciplined and highly organised setting. 

Schools are also ideal places for children to be taught to embrace and promote acceptance of people living with HIV/AIDS. It is necessesary to embark on education and awareness campaigns in schools. As leaders of tomorrow  school children must be empowered with information to enable them to lead productive lives and to take their rightful places in future. Interventions in schools is one of the most important strategies in the fight against the HIV/AIDS pandemic. Life skills programs and sexuality education are therefore a critical component of HIV/AIDS prevention. 

It is for this reason that the provincial government has established youth health centers across the province. These centers are accessible to all the youth, including those who are out of school. We are convinced that programs that focus specifically on the youth will help us win the war against HIV/AIDS. Making sexual health services more accessible and more user-friendly to youths is part of the long-term strategy to prevent HIV/AIDS. Many  health facilities are not youth-friendly. Young people continue to encounter too many obstacles as they seek information to help them cope with their sexuality, enhance their reproductive health and protect themselves against HIV and teenage pregnancy. Programs that focus specifically on youth will help us win the war on HIV/AIDS. South Africa will continue on the path of increasing young people's access to affordable and quality health care, information and related services. This will also strengthen preventive programmes that promote youth health. 

Young people who cannot make informed decisions or who do not have the capacity to negotiate safer sex must be encouraged to abstain from sexual activity. All people have a responsibility to promote a culture of abstinence and healthy lifestyles amongst the youth. The youth must be urged to postpone sexual activity until they are matured enough to be able to appreciate the full implications of sexual activity. Preferring to stay virgin is noble.

The following statistics are instructive
- 73% of young males had their first sexual experience at the average age of six. 
- 44% of young women had their first sexual intercourse at the age of 17. 
- 34% of young people have more than one sexual partner at a time. 
- On average they engage in sexual activity about 98 times a year with more than four partners. 
- 62% put sexual satisfaction of their partners before their own. 

It is particularly concerning that the rate of infection is higher among girls and women than it is among men, Dr. Molefi Sefularo points out. UNAIDS points out that lack of education about the virus is "a growing liability". Studies have confirmed that better-educated young girls tend to start having sexual relationships later. It is sad to note that in many parts of the world, cultural and social conditions prevent young girls from receiving education. The implication is that many girls are denied the right to inform themselves about their sexual and reproductive rights and options. 

Studies have shown that women (for biological reasons) are more vulnerable than men to sexually transmitted diseases and other opportunistic infections like HIV. This is especially marked in girls whose genital tracts are still not fully mature. Compounding biological vulnerability is the fact that women are far more likely to be coerced into sex, or raped - often by someone older, who has had greater exposure to the virus. 

Violence against women can also take less overt forms. Young girls often have sexual relationships with 'sugar daddies" who coerce them to have sex in exchange for gifts and favors. Such unequal relationships also have consequences for women, in terms of their risk of infection. World-wide, women between the ages of 15 and 24 also account for half of new HIV infections. 

The challenge is to find creative ways to change the social conditions that deny young women the ability to control practices that increase their vulnerability for contracting HIV. In many instances, women are still seen as sexual objects. Women bear the greatest burden of HIV/AIDS. The majority of young women cannot protect themselves against STD/AIDS because they have to rely on their male partners who may decide whether or not to use a condom. 

The nature of HIV/AIDS in Africa poses specific challenges. HIV/AIDS is devastating sub-Saharan Africa with unparalleled callousness. Clearly, Africa needs to map out its own response to this. As an essential part of the campaign against HIV/AIDS, the government is focusing on the elimination of poverty. 

It is inappropriate to blame everything around this epidemic on the HIV virus. Clearly, the relationship between HIV and other social ills afflicting society such as poverty and disease, particularly TB and STDs, is complex. A comprehensive response in the country needs to recognise this reality. 

Since 1998, the government has radically stepped up its campaign. It has done this in many ways, including the establishment of three powerful structures:
-A Ministerial Task Force, chaired by the Deputy President, to ensure a coordinated government response.
-A Partnership against AIDS, to ensure co-ordinated action by civil society - including business, the labour movement, youth, women and the religious community.
-A high-powered National Aids Council, again chaired by the Deputy President, which brings together government and civil society.
-The government has set up a dedicated fund to finance the fight against HIV/AIDS. This is in addition to funds that central, provincial and local government will spend on this campaign. 
-The government is funding work that is being done by the Medical Research Council to develop an AIDS vaccine. It is also doing everything possible to provide the necessary treatment and care for those affected by HIV/AIDS. 
-Earlier this year, the government released guidelines on the treatment of opportunistic infections. The STD (Sexually Treatment Diseases) and TB programs are also strengthened. 
-South Africa is also strengthening the national response to other public health challenges such as poverty and the provision of adequate safe water and sanitation. This is done because it is believed that the presence of these infections accelerates viral replication and therefore increases the rate of transmission. It is evident that countries that are resource-constrained  need to begin with these interventions because this is an effective response against HIV and AIDS.

- The government is also strengthening its national response to other public health challenges such as poverty and the provision of adequate safe water and sanitation. This is done because it is believed that the presence of these infections accelerates viral replication and therefore increases the rate of transmission. It is evident that countries that are resource-constrained like ours need to begin with these interventions because this is an effective response against HIV and AIDS.

- The government is supporting ongoing research in South Africa both on AZT and Niverapine. It is  indicated clearly some of the concerns that are well-known about side-effects of these drugs, including the development of resistance. It is also recognised that Niverapine, if it were to be proven to have a positive benefit \ risk profile, would present a better option for developing countries. This is because of its ease of administration as well as a relatively more favourable cost profile. It must be noted, however, that it is not the function of government to approve or register drugs. This is the task of the Medical Control Council (MCC), a statutory body established to deal with these matters.

South Africa continues to fight for an international dispensation that ensures greater access to ALL drugs for people in the developing world and the economically marginalised in the North. In this context, it also includes the availability of all effective treatment to deal with the epidemic of HIV/AIDS. People are encouraged by the growing support for such interventions as parallel importing, compulsory licensing and local manufacturing, and South Africa support these initiatives fully. 

These interventions will improve the capacity of developing nations to ensure greater access to drugs. It is  recognised the benefits that accrue to those who can afford the use of anti-retrovirals, but it is stressed that in the context of South Africa, this is far from reality.  The cost of these drugs is not the only deterrent to their use. It is necessary to systematically invest in and build health infrastructure so that advances in drug treatment can be made available to those who need it. The government will continue to provide access to treatment for those who have sexually transmitted infections, counselling and tests for those that would like to know their HIV status.

- Individuals are encouraged to practice safer sex by abstaining from sex where necessary and possible, remaining faithful to their sex partners when they are in a relationship and finally to always use a condom whenever there is a possibility of an unwanted pregnancy or of being infected with HIV and other sexually transmitted infections. 

- The power to defeat the spread of HIV/AIDS lies in our partnerships. As partners against AIDS, we can spread the message of prevention, acceptance of people living with HIV/AIDS, care and support for those infected and affected and pool all our resources. We can reduce HIV transmission through abstaining from intercourse, by being faithful to our spouses or partners and by always using a condom. AIDS has no cure, but can be prevented! There is no vaccine for HIV. For now, the best defence against HIV/AIDS remains prevention.

- The provincial government is confident that all units and sectors of the South African nation will join the MEC, North West in spreading information and knowledge about HIV and AIDS, supporting and caring for the infected and affected. Ultimately, we must address those social, economic and environmental factors that make the majority of  people poor, ignorant, powerless and prone to many diseases that place limitations on their freedom and quality of life.

Source: The Office of the MEC for Health, North West (South Africa)

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